Individual Benefits

Individual benefits are health, income and illness coverages a person buys for themselves rather than receiving through an employer. Sutherland Insurance, a Guelph, Ontario brokerage, places four of them through Edge Benefits: health and dental, injury-only income protection, critical illness, and business overhead expense.

What individual benefits does Sutherland Insurance arrange?

Key takeaways

  • Four products sit under individual benefits: health and dental, injury-only income protection, critical illness, and business overhead expense.
  • They are owned by the individual rather than an employer, so they continue through a change of job or a move into self-employment.
  • Most of the coverage is guaranteed issue, which means acceptance does not depend on answering medical questions. The drug upgrade and the illness options are the exceptions.
  • Edge Benefits issues these plans, and applications are completed online rather than through a paper process.
  • Health and dental pays toward costs OHIP does not. The other three replace income, pay a lump sum on diagnosis, or keep a business's fixed costs running.
Who it is for
Self-employed people, contractors, business owners without staff, retirees, and anyone between jobs
Products in this section
Health and dental, injury-only income protection, critical illness, business overhead expense
Legally required in Ontario
No, none of the four is compulsory
Insurer
Edge Benefits, with Sutherland Insurance as the broker
Application
Completed online; health cover starts the first of the month after approval
Area served
All of Ontario, from the Guelph office

What are individual benefits?

Coverage a person arranges in their own name, rather than receiving it as a benefit of employment. The contract belongs to the individual, so it does not end when a job does. Sutherland Insurance places four such products through Edge Benefits.

The distinction that matters is ownership. A group plan is arranged by an employer, priced on the group and generally ends with the employment. These are priced on the individual and continue regardless of who they work for.

That makes them the route for people whose income does not come with benefits attached: the self-employed, contractors, business owners without staff, and anyone between jobs or recently retired.

What can an Ontario individual benefits policy cover?

What a policy can cover

  • Health and dental: prescription drugs, dental treatment, vision, hearing and paramedical services, to the plan's annual maximums
  • Injury-only income protection: a monthly benefit while an injury stops the insured working
  • Critical illness: a lump sum on diagnosis of one of 34 covered conditions, subject to a 30-day survival period
  • Business overhead expense: a self-employed owner's fixed business costs while a disability stops them working
  • Guaranteed-issue options on each product, accepted without medical questions
  • Online application, with a licensed Sutherland Insurance broker available throughout

Commonly excluded under standard Ontario individual benefits wordings

  • Anything already diagnosed before a policy takes effect
  • Illness under the injury-only income protection, which insures injury alone
  • Vision and hearing under the base health plan, which are added by the health upgrade
  • An owner's personal income under business overhead expense, which pays the business's costs rather than the owner's salary
  • Group plans arranged by an employer for staff, which are a separate product
  • Costs above each plan's stated annual maximum

Exclusions vary by insurer and by policy form; the issued policy governs.

How much does individual benefits cost in Ontario?

The factors that move a Canadian personal health and dental premium, in approximate order of influence, and why insurers look at each one.

The factors that move a Canadian personal health and dental premium, in approximate order of influence, and why insurers look at each one.
Rating factorWhy
Age of the applicantClaim frequency for most health categories rises with age.
Number of people on the planEach added dependant adds its own claims exposure.
Coverage tier selectedA higher annual maximum and a lower deductible both raise the insurer's exposure.
Dental included or excludedDental claims are frequent and are priced as a distinct component.
Deductible selectedA higher deductible shifts more of each claim to the plan holder.
Province of residenceProvincial health plans, and what they leave uncovered, differ across Canada.
Smoking statusSome insurers file a separate smoker rate on health components.

Request a quote.

Are individual benefits required in Ontario?

No. None of the four is compulsory in Ontario. OHIP covers hospital and physician care, and these plans address costs and events it does not.

OHIP does not pay for most prescriptions taken outside hospital, dental treatment, vision correction or most paramedical services, and it does not replace income. Those are the gaps these products address.

Nothing on this page is a recommendation about which product suits a particular situation. A licensed advisor sets out what each covers and what it costs, and the decision rests with the applicant.

Who arranges individual benefits in Ontario?

People whose income does not come with a benefits plan attached. The four products are commonly held in combination rather than alone, because each leaves a gap the others fill.

A self-employed tradesperson with a leased yard might hold income protection for the household and business overhead expense for the business, because one insures earnings and the other insures rent and payroll.

Someone recently retired, or between contracts, more often starts with health and dental, because that is the cost that arrives immediately when a workplace plan ends.

A person with a family history of a listed condition may look first at critical illness, where the first tier is issued without questions about personal or family medical history.

How is an individual benefits plan arranged through Sutherland Insurance?

A licensed advisor goes through which of the four apply, then the application is completed online with Edge Benefits. Sutherland Insurance remains the broker on the plan.

Applying through a broker does not change Edge's process or its timing. It changes who reads the request, who works through the options before the form is submitted, and who is available afterwards when a claim raises a question.

Each product page sets out its own eligibility ages, benefit amounts, waiting periods and exclusions, taken from Edge Benefits' own published terms.

How do the four fit together?

Each covers a different consequence of the same event. Health and dental pays ongoing costs, income protection replaces earnings, critical illness pays a lump sum on diagnosis, and business overhead expense keeps a business's fixed costs running.

Someone unable to work through injury has three separate problems: the household's income stops, the business's rent does not, and treatment costs arrive. One product addresses one of those.

That is why they are commonly arranged together rather than chosen between, and why an advisor works through the set rather than a single product in isolation.

What makes Sutherland Insurance different from a direct insurer?

When a claim happens, Sutherland Insurance acts for the client with the insurer, and an in-house claims representative is available on any claim. Sutherland Insurance is an independent brokerage and compares the markets it holds contracts with rather than selling one company’s product. A person answers the phone at Sutherland Insurance, 519-822-0160, Monday to Friday, 8:30 a.m. to 5:00 p.m.

How Sutherland Insurance handles your insurance claim

Two people seated side by side at a wooden table, hands resting on an open notebook between two mugs of coffee.
Claims advocacy: Sutherland Insurance sits on the client's side of the table, not the insurer's.

Frequently asked questions

What is the difference between individual benefits and a group plan?

A group plan is arranged by an employer for its staff, priced on the group, and generally ends when the employment does. Individual benefits are owned by the person insured, priced on them, and continue through a change of job or a move into self-employment. Sutherland Insurance places both, separately.

Which of the four products are guaranteed issue?

Most of the coverage is. Health and dental issues its base and upgrade plans without medical questions, injury-only income protection is guaranteed issue between ages 18 and 69, and the first tier of critical illness asks nothing about personal or family medical history. The drug upgrade and the illness options are underwritten.

Do I need all four?

They address different consequences, and each product page sets out what its own covers and excludes. Nothing here is a recommendation about which combination applies to a particular household. A licensed Sutherland Insurance advisor goes through the options and the wording before an application is submitted.

Who is eligible for these plans?

Eligibility differs by product and is set out on each page. Broadly, they are issued to Canadians from age 18, with upper issue ages between 64 and 69 depending on the coverage. Business overhead expense additionally requires the applicant to be self-employed and working regular hours.

Does OHIP not already cover this?

OHIP pays hospital and physician costs. It does not pay for most prescriptions taken outside hospital, dental treatment, vision correction or most paramedical services, and it does not replace income or pay a business's rent. Those are the gaps these four products address.

Who is the insurer, and who is the broker?

Edge Benefits issues these plans and Sutherland Insurance is the broker on them. Applications are completed online through Edge Benefits, and Sutherland Insurance remains available afterwards, including when a claim raises a question about a definition, a limit or a waiting period. The brokerage has operated from Guelph since 1870.

These are the options. The right mix depends on the situation

The coverages above are the options generally available on an Ontario individual benefits policy. Which of them belongs on any particular policy depends on the property, the people insured, the limits selected and the individual insurer's wording. The policy document itself always governs. A licensed Sutherland Insurance broker can walk through the options and build a plan around your circumstances. Call 519-822-0160 or request a quote.

Get a personal benefits quote online

Sutherland Insurance places personal health and dental cover through Edge Benefits, which runs a live online quote and application. The quote takes a few minutes and no details are needed from Sutherland Insurance first.

Start an Edge Benefits quote (opens Edge Benefits in a new tab)

Opens the Edge Benefits site in a new tab. Sutherland Insurance remains your broker for the plan.

Get an individual benefits quote

A licensed Sutherland Insurance broker compares the available markets on every quote request.

Get an individual benefits quote Call 519-822-0160

A real person answers, Monday to Friday, 8:30 a.m. to 5:00 p.m.